U.S. residents less healthy than Canadians

A study by Harvard Medical School researchers in the July 2006 issue of the American Journal of Public Health finds that U.S. residents are less healthy than Canadians.

Moreover, despite spending nearly twice as much per capita for health care, U.S. residents experience more problems getting care and more unmet health needs.

The study analyzes the Joint Canada-U.S. Survey of Health, the first-ever cross national health survey carried out by the two nations’ official statistics agencies.

The authors found that U.S. residents were less healthy than Canadians, with higher rates of nearly every serious chronic disease examined in the survey, including diabetes, arthritis and chronic lung disease. U.S. residents also had more high blood pressure (18 percent of U.S. residents versus only 14 percent for Canadians). U.S. rates of obesity and sedentary lifestyle were higher, with 21 percent of U.S. respondents reporting obesity versus 15 percent of Canadians. However, U.S. residents were slightly less likely to smoke.

Canadians had better access to most types of medical care (with the single exception of pap smears). Canadians were 7 percent more likely to have a regular doctor and 19 percent less likely to have an unmet health need. U.S. respondents were almost twice as likely to go without a needed medicine due to cost (9.9 percent of U.S. respondents couldn’t afford medicine versus 5.1 percent in Canada).

After taking into account income, age, sex, race and immigrant status, Canadians were 33 percent more likely to have a regular doctor and 27 percent less likely to have an unmet health need.

Race and income disparities, although present in both countries, were larger in the U.S. Nonwhites were more likely than whites to have an unmet health need in the U.S. (18.6 percent vs. 11.1 percent), while in Canada they were not (10.8 percent vs. 10.2 percent). Notably, both white and nonwhite Canadians had fewer unmet health needs than white U.S. residents.

Poor U.S. residents (making less than $20,000 per year) were 2.6 times less likely to have a regular doctor than the affluent (those making $70,000 or more). In Canada, the poor were only 1.7 times less likely to have a regular doctor.

In the U.S., cost was the largest barrier to care. More than seven times as many U.S. residents reported going without needed care due to cost as Canadians (7 percent of U.S. respondents vs. 0.8 percent of Canadians). Uninsured U.S. residents were particularly vulnerable; 30.4 percent reported having an unmet health need due to cost.

Lead author Dr. Karen Lasser, primary care doctor at Cambridge Health Alliance and instructor of medicine at Harvard, commented, “Most of what we hear about the Canadian health care system is negative, in particular, the long waiting times for medical procedures. But we found that waiting times affect few patients, only 3.5 percent of Canadians vs. 0.7 percent of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada. Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down.”

“These findings raise serious questions about what we’re getting for the $2.1 trillion we’re spending on health care this year,” said Dr. David Himmelstein, associate professor of medicine at Harvard and study co-author. “We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live two to three years longer.”

Dr. Steffie Woolhandler, also an associate professor of medicine at Harvard and study co-author, commented: “Our study, together with a recent study showing that people in England are far healthier than Americans, is a terrible indictment of the U.S. health care system. Universal coverage under a national health insurance system is key to improving health. A single-payer national health insurance system would avoid thousands of needless deaths and hundreds of thousands of medical bankruptcies each year. In 1971, Congress almost passed national health insurance. Since then, at least 630,000 Americans have died because they failed to act. How much longer must we wait?”

Reprinted with permission from Physicians for National Health Care, www.pnhp.org.